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The Case of Mr. Perry and his Pacemaker
Mr. Perry was 83 years old and had several medical problems. He had spent the past several months in and out of hospitals and rehab. Prior to that, he lived independently in a small Midwestern town. Widowed many years ago, he subsequently enjoyed the company of a lovely lady friend who lived down the street from the Perry home. He had five adult children and numerous grandchildren.
Life should have been relatively good for this octogenarian. But life was not good. Not anymore. My body is all worn out. Im worn out. Dont want to do this anymore, Doc. They say I cant go home and be safe. And Im NOT going to a nursing home. No way! Just stop that little gadget that shocks me and the part that keeps my heart going. I want them stopped. Yes, the pacemaker, too. A magnet will stop it, right? Just do it. Please.
Mr. Perry had a cardiac resynchronization therapy defibrillator (CRT-D) implanted a few years ago. It included an electrical pacing component for heart rhythms, on which the patient was 100% dependent. The defibrillator had shocked him, more than once, just before he came to the hospital E.R. with this request. That was the last straw for Mr. Perry. No more shocks for him. No nursing home or rehab or hospitalizations or medications. And no more mechanical pacing either. Im tired of fighting.
Deactivating an internal defibrillator is one thing. The patients cardiologist didnt need an ethics consultation for that decision. If he doesnt want to be shocked again, thats his decision. And if it went off again after hed requested it stopped, that could be a kind of torture, she reasoned. Deactivation happened quickly after admission from the Emergency Department. A Do Not Attempt Resuscitation order was placed in the chart.
But the pacemaker, also? He wanted it stopped. Ought we do so? Would that be ethically respectful of this patients autonomy? Or would it be physician-technician assisted suicide?
If we stop the pacemaker, Mr. Perry, you will die within a few minutes.